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Chapter 10:

Abnormal Development, Diagnosis, & Psychopharmacology. Chapter 10:. Why Study Abnormal Behavior, Diagnosis, and Medication?. Read vignettes, middle of p. 323 Reasons to study abnormal developmental, diagnosis, & medication—see 11 reasons p. 324

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Chapter 10:

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  1. Abnormal Development, Diagnosis, & Psychopharmacology Chapter 10:

  2. Why Study AbnormalBehavior, Diagnosis, and Medication? • Read vignettes, middle of p. 323 • Reasons to study abnormal developmental, diagnosis, & medication—see 11 reasons p. 324 • You can’t have one without the other (abnormal behavior, diagnosis, and medication) • If you believe in extreme deviations from the norm (mental disorders and abnormal behavior), then you are going to want to understand it—classify it • If you classify it (diagnose disorders), then you (or the clients) are going to want to be treated • One form of treatment is medication

  3. Personality Development and Abnormal Behavior • Genetic and Biological Explanations • Genetics subset of biology • If disorders are biologically based, it would make sense to treat them biologically • Treating biologically can be broad-based, such as: • Medication • Stress reduction • Exercises • Amount of light we receive • Proper amount of sleep • Etc.

  4. Personality Development and Abnormal Behavior (Freud) • Born all Id • Develop ego and superego as we pass through the psychosexual stages • Experiences through the stages effects personality development • Extremely poor parenting leads to development of maladaptive behaviors as our defense mechanism attempt to control the impulses of our id • Discuss how various parenting styles may affect development • Parents who are obsessively strict • Parents who extensively praise

  5. Personality Development and Abnormal Behavior (Learning Theory) • Learning occurs through operant conditional, classical conditioning, or modeling • Principles of operant conditioning explains many of the ways that individuals develop (see p. 330) • Major factors that lead to healthy or dysfunctional personality: • Born capable of multiple personality characteristics • Behaviors and cognitions continually reinforced • Reinforcements can be very complex and subtle • Abnormal behavior result of reinforcement • Analysis of reinforcements leads to understanding of person • New behaviors learned by applying principles of learning

  6. Personality Development and Abnormal Behavior (Humanistic Approach) • Maslow and Rogers most influential • Maslow: We exhibit characteristics based on our placement in need hierarchy (See Figure 10.1, Page 332) • Rogers: How significant others treat us results in our personality development (and placement on Hierarchy) • We all need to be loved • Conditions or worth placed on us • To gain love, we respond to others based on conditions of worth—leads to false self • With empathy, genuineness, and unconditional positive regard we can rediscover our “true” selves

  7. Personality Development and Abnormal Behavior (Post-modernism and Social Constructionism) • Post-modernism • Questioning of modernism • “Truth” is a construction • Social Constructionism • Language creates reality through discourse • Thus, our realities are created through our discourses with others and how “reality” is passed down through society • Conclusion • Abnormal behavior is simply a social construction • Perhaps, the mental health field plays a part in continuing this deception

  8. Comparing Models and Integrating Models • See Comparison of Models Table 10.1 Page 336 • Today, many clinicians integrate the models

  9. Diagnosis and Abnormal Behavior: What Is DSM-IV-TR? • Greek words: Dia (apart) and gnosis (to perceive or know) • DSM-I: 1952 • DSM-IV-TR: Five Axes • Axis I: All Disorders Except Personality Disorders or Mental Retardation • Axis II: Mental Retardation and Personality Disorders • Axis III: General Medical Conditions • Axis IV: Psychosocial/environmental Problems • Axis V: Global Assessment of Functioning • DSM-5 to come out in 2013 • Advantages and Disadvantages of DSM

  10. Axes I and II: The Mental Disorders • Offers information on: • Disorder’s main features • Subtypes and variation in client presentations • Typical pattern, course, or progression of symptoms • How to differentiate disorders • See Table 10.2, Page 340 • Axis I includes all disorders except personality disorders or mental retardation (in DSM-5, to be called Intellectual Disability). • Axis II is personality disorders and mental retardation

  11. Axes I: Clinical Disorders and Other Conditions that May be a Focus of Clinical Attention • *Disorders usually diagnosed in infancy, childhood, or adolescence • Delirium, Dementia, Amnestic, and Other Cognitive Disorders • Mental Disorders Due to A General Medical Condition • Substance-Related Disorders • Schizophrenia and Other Psychotic Disorders • Mood Disorders • Anxiety Disorders • *Factitous Disorders • Dissociatve Disorders • Sexual and Gender Identity Disorders • Eating Disorders • Sleep Disorders • Impulse Control Disorders Not Elsewhere Classified • Adjustment Disorders • *See pp. 339-341 for descriptions

  12. Axis II Disorders: Personality Disorders and Mental Retardation • Listed on Axis II because treatment has little or no effect. • Mental retardation: Intellectual functioning significantly below average • Personality Disorders: Deeply ingrained, inflexible, enduring patterns of behavior • Cluster A: odd or eccentric. • Disorders: paranoid, schizoid, and schizotypal • Cluster B: dramatic, emotional, overly sensitive, and erratic • Disorders: antisocial, borderline, histrionic, and narcissistic • Cluster C: anxious and fearful • Disorders: avoidant, dependent, and obsessive-compulsive

  13. Axes III, IV, and V • Axis III: General Medical Conditions • Use ICD-9-CM for diagnosis • List on Axes I or II also if cause of disorder • Axis IV: Psychosocial and Environmental Problems • List on Axes I or II also if cause of disorder • Axis V: Global Assessment of Functioning Scale • See Table 10.3, p. 343

  14. Making a Diagnosis Using All Five Axes of DSM-IV-TR • Example of Multiaxial Diagnosis • Axis I 309.0 Adjustment Disorder with Depressed Mood • Axis II 301.82 Avoidant Personality Disorder • Axis III No Diagnosis • Axis IV Divorce • Axis V GAF=60 (current); 75 (highest in past year)

  15. Psychopharmacology • Antipsychotics (neuroleptics) • 1950s: First wave of antipsychotics • Today: Many different kinds • Today, three types: conventional, atypical, 2nd generation • See Table 10.5, p. 345 • Side effects are many: anticholinergic, extrapyramidal, tardive dyskinesia, mood disorders, other • Mood-Stabilizing Drugs (e.g., for bipolar disorder) • 1950s: Lithium • Today: Lithium, anticonvulsant drugs, benzodiazepines, other

  16. Psychopharmacology • Antidepressants • 1930s: amphetamiens • 1950s: MAOIs and Tricyclics • More recently: SSRIs and atypical anti-depressants • Anti-anxiety Medications • 1960s: Librium, Valium • Later, more benzodiaspenes (Tranzene, Zanax, more • Nonbenzodiaspeines: Buspar , Gepirone, Other • For generalized anxiety disorder, obsessive-compulsive disorder, other

  17. Psychopharmacology • Stimulants • Later 1800s: Cocaine and amphetamines for diet aid, emotional disorders • Today: Mostly used for ADHD • Also used for narcolepsy • Most common: Ritalin, Cylert, and Dexedrine • Warning: All have side affects • Many different drugs today exist

  18. Multicultural/Social Justice Focus • Misdiagnosis of Minority Clients • Symptomatology may vary as a function of culture • Does DSM-IV-TR truly take into account affects of oppressive society? • Some say: DSM-IV-TR legitimizes the concept of “disorder” thus making it acceptable to oppress those with the disorder

  19. Multicultural Issues /Social Justice Focus • DSM-IV-TRs attempt to address cross-cultural issues • Much greater attention to issues of age, gender, socioeconomic status, and culture • Also has 25 “Culture-bound Syndromes” • E.g.: “Koro” “A term, probably of Malaysian origin, that refers to an episode of sudden and intense anxiety that the penis (or in females, the vulva and nipples) will recede into the body and possibly cause death. . . .” (APA, 2000, p. 900)

  20. Ethical, Professional, & legal Issues(Ethical Issues) • Ethics Code: • ACA’s 2005 code addresses a number of important issues relative to diagnosis • Proper diagnosis: B e careful to ensure proper diagnosis • Cultural Sensitivity: Be sensitive to how cultural background can affect the manner in which the client expresses self • Historical and Social Prejudice: Counselors should understand and recognize that some groups have been misdiagnosed and pathologized • Refraining from Making a Diagnosis: Refrain from diagnosing if you think if making a diagnosis will harm client

  21. Ethical, Professional, & Legal Issues(Professional Issues) • DSM-5 (probably, 2013) • May collapse Axis I and Axis II • Other? • Challenging Abnormality and Diagnosis • Some say mental illness is a normal response to a stressful situation (e.g., Laing and Szasz) • Glasser believes psychopathology is a client’s clumsy attempt at meeting his or her needs

  22. Ethical, Professional, & Legal Issues(Professional Issues) • Challenging Abnormality and Diagnosing (Cont’d) • Ivey and Ivey suggest diagnosis may be a normal response to developmental issues (see Box 10.3, p. 351) • Corey: feasons why clinicians should be careful when diagnosing (see bottom of p. 350) • Overdiagnosis of Mental Illness • Because we have DSM, do we naturally overly diagnose? • See Box 10.4, p. 352: On Being Sane in Insane Places

  23. Ethical, Professional, & Legal Issues(Legal Issues) • Confinement Against One's Will • Donaldson v. O’Connor (1975): People can’t be held against their will unless there is danger to self or others • Today, usually need a hearing to have people confined against their will • Insurance Fraud • Some diagnoses may not be paid by insurance companies • Some clinicians give alternative diagnoses in order to get paid • Giving an alternative diagnosis is illegal

  24. The Counselor in Process • Dismissing Impaired Graduate Students • Should we dismiss students at all? • Should we view students from DSM? • Should we take a developmental perspective and assist students to strive toward wellness? • ACA code suggests: • Assist students in securing remedial assistance • Seek professional consultation and document decision to dismiss or refer students • Ensure students have recourse in a timely manner to address issues of referral or dismissal

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